General Surgery Principles — MCQs

General Surgery Principles Indian Medical PG Practice Questions and MCQs

Question 911: Which of the following is NOT a criterion for the viability of muscle?

A. Contractility
B. Intact fascia (Correct Answer)
C. Colour
D. Bleeding when cut

Explanation: ***Intact fascia*** - The **fascia** is a connective tissue sheath surrounding muscles; its intactness is **not a direct indicator of muscle viability**. - While important for muscle integrity and function, a healthy, viable muscle can still exist even if its overlying fascia is disrupted or surgically opened. *Colour* - **Healthy muscle** generally has a **reddish-pink colour** due to its rich blood supply and myoglobin content. - **Pale, dusky, or black muscle** suggests **ischemia or necrosis**, indicating poor viability. *Contractility* - **Viable muscle** should be able to **contract** in response to direct electrical stimulation or mechanical irritation. - The **absence of contractility** indicates **muscle death or severe damage**, making it non-viable. *Bleeding when cut* - **Viable muscle** has an **intact blood supply** and will **bleed when incised**. - **Lack of bleeding** suggests **severe ischemia or necrosis**, indicating the muscle is non-viable.

Question 912: Which nerve is most commonly damaged during hernia repair?

A. Iliohypogastric nerve
B. Genitofemoral nerve
C. No nerve damage
D. Ilioinguinal nerve (Correct Answer)

Explanation: ***Ilioinguinal nerve*** - The **ilioinguinal nerve** runs in close proximity to the inguinal canal, making it vulnerable to injury during dissection and suture placement in hernia repair. - Damage can lead to **neuropathic pain**, a common complication in the groin and medial thigh region post-surgery. *Iliohypogastric nerve* - The **iliohypogastric nerve** is also superficial and can be injured, but less frequently than the ilioinguinal nerve. - Injury typically results in sensory deficits over the **suprapubic region** and upper part of the medial thigh. *Genitofemoral nerve* - The **genitofemoral nerve** typically lies deeper and more medially within the psoas muscle, making it less susceptible to direct injury during standard inguinal hernia repair. - Damage would primarily affect sensation in the **anterior thigh** and could impact the **cremasteric reflex**. *No nerve damage* - Although efforts are made to avoid nerve injury, the close anatomical relationship of several nerves to the inguinal canal means that **nerve damage is a recognized potential complication** of hernia repair, ranging from minor irritation to transection. - Post-herniorrhaphy **neuropathic pain** is a significant concern, directly attributable to nerve involvement.

Question 913: Multiple air fluid levels in X-ray of abdomen are seen in

A. Hollow viscera perforation
B. Pyoperitoneum
C. Intestinal obstruction (Correct Answer)
D. None of the options

Explanation: ***Intestinal obstruction*** - **Air fluid levels** are a classic radiographic sign of bowel obstruction, resulting from the accumulation of gas and fluid proximal to the obstructed segment. - The obstructed bowel segments fill with ingested air and digestive fluids, forming distinct horizontal fluid levels layered below gas bubbles, particularly evident on **erect or decubitus abdominal X-rays**. *Hollow viscera perforation* - This condition is characterized by the presence of **free air under the diaphragm** (pneumoperitoneum), not typically by multiple air-fluid levels within the bowel loops. - While fluid might extravasate, the primary radiographic finding is *free intraperitoneal gas*, indicating a breach in the luminal wall. *Pyoperitoneum* - Refers to the presence of **pus within the peritoneal cavity**, which would manifest as diffuse fluid accumulation rather than discrete air-fluid levels within bowel segments. - While gas might be present if associated with a gas-forming infection, it's not the primary or defining characteristic like the ordered air-fluid levels of obstruction. *None of the options* - This option is incorrect because **intestinal obstruction** is a well-established cause of multiple air-fluid levels on abdominal X-rays. - The other conditions listed do not typically present with this specific radiographic pattern as their primary or defining feature.

Question 914: Most common cause of acute abdomen in a young girl?

A. Acute appendicitis (Correct Answer)
B. Ovarian torsion
C. Renal colic
D. Mittelschmerz

Explanation: ***Acute appendicitis*** - **Acute appendicitis** is the most common cause of acute abdomen in children and young adults, including young girls. - Its high incidence across this age group makes it the leading diagnosis for acute abdominal pain requiring surgical intervention. *Ovarian torsion* - While it can cause severe acute abdominal pain in young girls, **ovarian torsion** is less common than appendicitis. - It often presents with sudden onset, severe, unilateral lower abdominal pain, sometimes with a palpable mass. *Mittelschmerz* - "**Mittelschmerz**" refers to pelvic pain experienced by some women during ovulation, typically mid-cycle. - This is a physiological event, not an acute surgical emergency, and the pain is usually mild and self-limiting. *Renal colic* - **Renal colic** is caused by kidney stones and is characterized by severe, colicky pain radiating from the flank to the groin. - While possible, it is less common in young girls compared to appendicitis and often associated with urinary symptoms.

Question 915: What type of knot is depicted in the image?

A. Half hitch
B. Granny knot (Correct Answer)
C. Surgeon’s knot
D. Reef knot

Explanation: ***Granny knot*** - The image shows a knot where the two half-knots are tied in the **same direction** (left over right, then left over right again, or vice versa), causing it to be unstable and slip. - This instability makes it less secure than a reef knot, as the two end pieces emerge parallel but on opposite sides of the loop. - The granny knot is an **insecure knot** that should be avoided in surgery as it can spontaneously untie. *Surgeon's knot* - A surgeon's knot involves an **extra throw** (double wrap) around the first loop to increase friction and make it more secure, which is not depicted here. - It is typically used to ensure that the first throw holds tension while the second throw is being tied. *Reef knot* - A reef knot (or square knot) is formed by tying two half-knots in **opposite directions** (left over right, then right over left), which creates a flat, stable, and secure knot. - In a reef knot, the two end pieces emerge parallel and on the same side of the loop, unlike the granny knot. *Half hitch* - A half hitch is a simple overhand knot around a standing part of the rope, used as a single throw or in combination with other knots. - It is not the same as the double-throw configuration shown in the image.

Question 916: Which of the following is not a component of the Thoracoscore?

A. Surgery priorities
B. ASA classifications
C. Expected complications post-surgery (Correct Answer)
D. Performance status

Explanation: ***Expected complications post-surgery*** - While patient risk assessment tools aim to predict surgical outcomes, the **Thoracoscore** specifically calculates risk based on present patient characteristics and surgical plan, not based on a list of expected complications. - Expected complications are a *result* of the risk score, not an input into its calculation. *ASA classifications* - The **American Society of Anesthesiologists (ASA) Physical Status Classification System** is a crucial component of the Thoracoscore, reflecting the patient's overall health status and comorbidity burden. - A higher ASA classification indicates greater surgical risk and contributes to the Thoracoscore calculation. *Surgery priorities* - **Surgery priority** (e.g., elective, urgent, emergency) is an important factor in the Thoracoscore, as urgent or emergent surgeries are associated with higher risk. - This parameter helps categorize the immediacy and complexity of the surgical intervention. *Performance status* - The patient's **performance status**, often assessed using scales like the Eastern Cooperative Oncology Group (ECOG) or Karnofsky, is a significant predictor of surgical outcome and is included in the Thoracoscore. - A lower performance status (indicating poorer functional capacity) increases the calculated surgical risk.

Question 917: Identify the surgical instrument based on the following characteristics: short blades, sharp cutting edges, and a central screw or rivet. Commonly used for cutting sutures.

A. Metzenbaum Scissors
B. Suture Scissors (Correct Answer)
C. Mayo Scissors
D. Iris Scissors

Explanation: ***Suture Scissors*** - Characterized by **short, sharp blades** and a central screw, making them ideal for precision cutting of sutures. - Their design allows for a **clean cut** through suture material without fraying, which is crucial in surgical settings. - Also known as **stitch scissors** or suture removal scissors, commonly used for cutting sutures during wound closure or suture removal. *Metzenbaum Scissors* - Known for their **long, slender shafts** and delicate blades, primarily used for **dissecting delicate tissues**. - Designed for blunt and sharp dissection of fine tissues rather than suture cutting. - Their longer, more delicate design makes them less ideal for the quick, precise cutting required for suture removal. *Mayo Scissors* - Possess **sturdy, heavy blades** that can be straight or curved, designed for cutting **tough tissues**, fascia, and heavy sutures. - Their robust construction is designed for cutting dense tissue rather than the fine, precise work of routine suture cutting. - Available in straight (for cutting sutures on skin) and curved (for cutting deep tissues) varieties. *Iris Scissors* - These are very **fine, delicate scissors** with extremely sharp, pointed tips, mainly used in **ophthalmic surgery** and other microsurgical procedures. - While they **can cut fine sutures** (6-0, 7-0) with precision, they are more specialized for delicate tissue dissection. - Their very fine tips make them less suitable as general-purpose suture scissors compared to dedicated stitch scissors.

Question 918: A person reports 4 hours after having a clean wound without laceration. He had taken TT 10 years before. The next step in management is:

A. Single-dose TT (Correct Answer)
B. No need for any vaccine
C. Full course Tetanus vaccine to be given
D. Full dose TT with TIG

Explanation: ***Single-dose TT*** - For a **clean wound** when the last **tetanus toxoid (TT)** was given **10 years ago**, a **booster dose** is indicated as the protective immunity duration is **10 years**. - **TT provides immunity for 10 years** for clean wounds; at the 10-year mark, the protective window has elapsed and requires a booster. *No need for any vaccine* - This would be correct only if the last TT dose was given **<10 years ago** (within the protective window). - At exactly **10 years**, the immunity has waned and a **booster is required** for continued protection against tetanus. *Full course Tetanus vaccine to be given* - A **complete primary series (3 doses)** is only indicated for patients who are **unimmunized** or have **unknown vaccination history**. - This patient has documented **prior TT immunization**, so only a **single booster dose** is needed, not a full course. *Full dose TT with TIG* - **Tetanus Immunoglobulin (TIG)** is reserved for **high-risk scenarios**: tetanus-prone wounds in patients with **inadequate immunization** (<3 doses) or **unknown vaccination status**. - For a **clean wound** with documented prior immunization, **TIG is unnecessary** and represents over-treatment.

Question 919: Which of the following is a common indication for performing a tracheostomy?

A. Prolonged mechanical ventilation requiring intubation for more than 7-10 days (Correct Answer)
B. Severe respiratory distress due to tracheal stenosis
C. Severe airway obstruction due to a foreign body
D. Chronic obstructive pulmonary disease (COPD) exacerbation

Explanation: ***Prolonged mechanical ventilation requiring intubation for more than 7-10 days*** - The **most common indication** for tracheostomy is **prolonged mechanical ventilation** when endotracheal intubation is expected to extend beyond **7-10 days**. - Tracheostomy offers advantages over prolonged endotracheal intubation including: reduced **laryngeal injury**, improved **patient comfort**, easier **pulmonary toilet**, decreased sedation requirements, and facilitated **weaning from ventilator**. - This is the standard indication in ICU settings for patients with respiratory failure, neurological conditions, or post-operative states requiring extended ventilatory support. *Severe respiratory distress due to tracheal stenosis* - While **tracheal stenosis** can cause respiratory distress, the definitive treatment is surgical repair (e.g., **tracheal resection and anastomosis**) or **stenting**. - Tracheostomy may be used as a temporary measure or when definitive repair is not feasible, but it's not the most common indication. - The tracheostomy would need to be placed **below the level of stenosis** to be effective. *Severe airway obstruction due to a foreign body* - **Acute foreign body obstruction** requires immediate intervention: **Heimlich maneuver**, **direct laryngoscopy**, or **bronchoscopy** for removal. - Tracheostomy is a **last resort** only in cases of complete obstruction where intubation is impossible and other methods have failed. - This is an emergency procedure, not a common elective indication. *Chronic obstructive pulmonary disease (COPD) exacerbation* - COPD exacerbations are managed with **bronchodilators**, **steroids**, and if needed, **non-invasive positive pressure ventilation (NIPPV)** or **endotracheal intubation**. - Tracheostomy is not indicated for COPD exacerbation itself, though it may be considered if prolonged ventilation (>7-10 days) becomes necessary. - COPD alone is not an indication for tracheostomy.

Question 920: Which of the following layers are cut during fasciotomy ?

A. Skin
B. Skin+subcutaneous tissue+Superficial fascia
C. Skin+subcutaneous tissue+Superficial fascia+deep fascia (Correct Answer)
D. Skin+subcutaneous tissue

Explanation: ***Skin+subcutaneous tissue+Superficial fascia+deep fascia*** - A **fasciotomy** is a surgical procedure to relieve **compartment syndrome** by releasing the **deep fascia** that constricts muscle compartments. - To access and incise the deep fascia, all overlying layers must be cut: **skin**, **subcutaneous tissue** (also called superficial fascia or hypodermis), and finally the **deep fascia** itself. - Note: "Superficial fascia" and "subcutaneous tissue" refer to the same anatomical layer, but both terms are listed here to reflect common clinical terminology. *Skin* - Cutting only the skin does not provide access to the deep fascia and cannot relieve compartment syndrome. - The skin is merely the outermost protective layer. *Skin+subcutaneous tissue* - While both these layers must be incised, stopping here leaves the **deep fascia** intact. - The deep fascia is the primary constricting structure in compartment syndrome and must be released. *Skin+subcutaneous tissue+Superficial fascia* - This option is anatomically redundant since superficial fascia and subcutaneous tissue are the same layer. - More importantly, this still does not include division of the **deep fascia**, which is essential for decompression in a true fasciotomy.

Practice by Chapter

Wound Healing and Care

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Surgical Infections

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Fluid and Electrolyte Management

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Nutrition in Surgical Patients

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Hemostasis and Blood Transfusion

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Surgical Instruments and Equipment

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Sutures and Stapling Devices

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Minimal Access Surgery Principles

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Surgical Complications

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Anesthesia Principles for Surgeons

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Surgical Oncology Principles

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Evidence-Based Surgery

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